61 year old male chest pain
61 year old male patient with no history of coronary issues went to a local urgent care facility after he began having substernal chest pain while at rest. He stated he had some radiation of pain and numbness to his left arm. The chest pain was described as tightness and was 8/10. No vomiting but has been nauseated. Nothing has made the pain better or worse and is not reproducible on palpation. When asked if he had shortness of breath he stated he did.
BP 130/80
The urgent care facility obtained a 12 lead ekg.
HR 52 BPM
PR 174ms
QRS 110ms
QT 420ms
QTC 405ms
How would you proceed with this patient?
Click this link to go to the update 61 year old male chest pain
12LEADEKG 
LAD Inf elevation with flip T waves, and Lat reciprocal changes. Sinus Brady Cardia unable to see EKG for poss. A-V blk
Very slight inferior ST elevation, 2 mls tops. With Lateral lead depression. Underlying rhythm Sinus Brady.
PT already in urgent care? IF Pre-hospital – Aspirin and GTN – IV Morphine (If pain is still present).
Pre-alert hospital and transport to Resus/PPCI depending on which area you work in.
? PE
EKG shows sinus bradycardia with slight ST elevation. Start an IV with NS 1000 ml tko. administer 325 mg asprin and 0.12 mg Nitro SL, and 5mg MS iv push. If pulse drops below 50, push 0.5 atropine or 1mg Epi.